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The effect of different doses of ketamine on intraocular pressure in anesthetized children
N G Nagdeve1, S Yaddanapudi, S S Pandav
1Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Low-dose ketamine (3 mg/kg) did not change intraocular pressure (IOP) in anesthetized children, unlike higher induction doses (6 mg/kg). This suggests lower ketamine doses are safer for pediatric procedures like parental separation.
Area of Science:
- Pediatric Anesthesiology
- Ophthalmology
- Pharmacology
Background:
- Ketamine commonly increases intraocular pressure (IOP) during anesthesia induction.
- The impact of low-dose ketamine, used for pediatric parental separation, on IOP is not well-established.
Purpose of the Study:
- To investigate the dose-dependent effects of ketamine on intraocular pressure (IOP) in anesthetized children.
- To compare the IOP changes between a standard induction dose and a low dose of ketamine.
Main Methods:
- Forty children (1-6 years) received either 6 mg/kg or 3 mg/kg ketamine intramuscularly post-induction with halothane.
- Intraocular pressure was measured using a Perkins tonometer at baseline and for 20 minutes after ketamine administration.
- An observer, unaware of the ketamine dose, recorded IOP measurements.
Main Results:
- The 6 mg/kg ketamine dose caused a slight, temporary increase in IOP (5-10 minutes post-administration).
- The 3 mg/kg ketamine dose did not significantly alter IOP.
- The higher ketamine dose group showed significantly higher IOP compared to the low-dose group at 5 minutes.
Conclusions:
- Ketamine exhibits a dose-dependent effect on IOP in pediatric patients under halothane anesthesia.
- Low-dose ketamine (3 mg/kg) appears safe regarding IOP changes, while higher doses increase IOP.
- Higher ketamine doses were associated with increased postoperative airway obstruction and sedation.
Background:
When used for induction of anesthesia, ketamine usually increases intraocular pressure (IOP). However, the effect of low doses of ketamine, which are used for parental separation in children, is unknown. We studied the effect of two different doses of ketamine on IOP in anesthetized children.
Methods:
Forty children age 1 to 6 years who met American Society of Anesthesiologists physical status I criteria scheduled to undergo surgery were randomly selected to receive either an induction dose (6 mg/kg) or a low dose (3 mg/kg) of ketamine intramuscularly. Anesthesia was induced and maintained with halothane, and ketamine was injected 10 minutes after induction. Intraocular pressure was measured using a Perkins applanation tonometer before ketamine administration and every 5 minutes thereafter for 20 minutes by an observer who was unaware of the ketamine dose used. 10.8 +/- 2.2 mm Hg to 12.6 +/- 2.8 mm Hg at 5 minutes and 11.9 +/- 2.5 mm Hg at 10 minutes after administration of ketamine in the induction-dose group. There was no significant change in IOP after administration of ketamine in the low-dose group. Intraocular pressure was significantly higher in the induction-dose group compared to the low-dose group at 5 minutes after administration of ketamine. More patients in the induction-dose group had postoperative airway obstruction and sedation than in the low-dose group.
Conclusions:
In children anesthetized with halothane, ketamine had a dose-dependent effect on IOP, with 6 mg/kg of the drug causing a small increase in IOP at 5 to 10 minutes and 3 mg/kg not altering the IOP. The higher dose of ketamine also was associated with an increased incidence of postoperative complications.
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